Acute Behavioural Disorder

You’ve may heard the term ‘Excited delirium’? I wrote a blog on it a few years ago. You may also have heard the term ‘acute behavioural disturbance’ or ‘acute behavioural disorder’? … these things may, in fact, be the same thing. Or they may not be the same thing. Actually, it may be three separate things or they may not even be a thing. Or things.

I hope I’ve cleared up the science behind these terms for you?

You may well have noticed: I’m neither a doctor nor a scientist – I ditched my science education at 16yrs old so it’s fair to say that I’m not the best person to ask about this stuff.  You should probably ring a doctor … or doctors. Actually, if you’re going to ring a doctor, you should ring more than one because there is a distinct possibility that you’ll select one that will give you an answer that most of the others don’t agree with. You see, the medical profession are still debating this stuff and I’ve covered this point before – several times. There are doctors of various kinds who will tell you if you stand still long enough that these are not valid medical or scientific terms – some will go further and insist that they are actually quite meaningless, not mentioned in the medical classifications of disease, etc.. There are others who will stop short of that, by accepting that more needs to be known and that to the extent there is any validity in any of these terms, they probably need to be used very carefully to describe certain, specific medical issues when presented in particular circumstances where the effect of (not always illegal) drugs are often involved.  And all of this before we even begin to discuss the issue of restraint and policing.

Professor Hugh MONTGOMERY and Dr Fionna MOORE, the medical director of the London Ambulance Service feature in the training film Safety In Mind, jointly produced by South London and Maudsley NHS Trust, the LAS and the Metropolitan Police. I invite anyone who thinks this stuff is not a real thing, to contact them and have it out in the seminar room (or the car park if you have to) – let me know the outcome of the discussion.

THE LAW AND MEDICINE

Meanwhile in the real world, 999 calls keep coming in to the police. Difficult situations and challenging members of society are being increasingly deflected in to the emergency system (not just the police!) by other mechanisms of social justice that are contracting before our eyes and re-defining their priorities and their paradigms, to justify radical service re-design.  At least twice in 2015, Her Majesty’s Coroners have returned narrative verdicts of deaths connected to these various concepts and accompanied by other mechanisms. We keep seeing Regulation 28 notices from Coroners expressing reservation about these things and seeking improvement.

Meanwhile in medicine, the Royal College of Emergency Medicine are apparently holding weekend seminars and drafting new guidelines for ABD. The National Institute of Clinical Excellence (NICE) have updated their 2005 guidelines on the short-term management of disturbed behaviour and phrases along these lines are included. In fairness, they were included in 2005, too.

So you can form you own view and think what you want about the aetiology of so-called ABD or Excited Delirium: I’m utterly unqualified to take a position on it or to tell you what to think. What I can say, because I’m a professional legal officer, is that courts rule that people die from this. I can also point out that Doctors with more or less equal right to be taken seriously are contradicting each other as badly as lay people are likely to do if they were brought in to debate the whole thing. I can also point out that published documents from medical authorities like Royal Colleges, NICE or academic journals mention these things.

MAKING DECISIONS AMIDST AMBIGUITY

I’m genuinely way beyond caring, strictly speaking, whether this is syndrome, a disorder or a condition – I’m not even bothered whether it is a thing. What I am bothered about is people dying in police custody after the same weary old story of a police intervention with someone who was often well-known to mental health services, who may have taken drugs – and I don’t distinguish between illegal drugs or prescribed medication because we all know that the latter can go badly awry – and then a restraint related intervention happens which various reputable sources tell us should be treated as a medical emergency, except for that inconvenient fact that the NHS is often unable to support the officers’ decision-making.

If you’re spending your time wondering about whether Acute Behavioural Disorder is a thing – I’m told this is the latest term for whatever it is people are trying to define and describe – then you’re wondering about the wrong thing, legally speaking. And as I’m a policeman, not a doctor, I tend to think and speak legally rather than clinically. (Must remember to refresh my first aid certificate.) And legally, things are very, very clear: Coroners in Her Majesty’s Courts are telling us people have died and that we need to do more and we need to do better.

This BLOG is a short one because the points have been made previously and elsewhere by others. It’s one of those zombie discussions that doesn’t go away, because people keep making the same points as if the unresolved medical debates mean we can keep disregarding the adverse Coroner’s findings. If the legal system is guilty of having to make real decisions in the real world amidst uncertainty and ambiguity, then I can live with that. What I can’t easily reconcile is the shouting from the sidelines that this thing is not a thing, without any real effort to support the frontline police officers and paramedics who are having to deal with the reality of a world in which we all knew before we started that we don’t know everything.  As President Theodore ROOSEVELT once remarked, “It’s not the critic who counts … it’s the man [sic] who is actually in the arena.”


IMG_0053IMG_0052Winner of the President’s Medal fro
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


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27 thoughts on “Acute Behavioural Disorder

  1. I would call it Akathisia and this is a condition I have seen at first hand. My daughter said that it felt like she was crawling out of her skin. Akathisia was caused by the drugs and no wonder why – I can now see in the files the enormous amount of concomitantly Prescribed drugs given yet this is put down as “illness”. – now I have proven by turning to leading experts in Holland that my daughter cannot metabolise the drugs so “excited delirium”as you call it is Akathisia in other words caused by the drugs

  2. ‘Exited Delerium’ has not even been postulated as an hypothesis, let alone a valid scientific theory. It was originally put forward by representatives of the TASER manufacturers (and we’ve recently seen the lengths these scumbags will go to: https://reason.com/blog/2015/12/12/taser-trolls) in civil wrongful death lawsuits. If we’re honest about it, it was also siezed upon by certain law enforcement ‘professionals’ in the States as a way of absolving themselves and incompetent Coroners who actively assisted them – deliberately or not.

    1. And yet psychiatrists in Edinburgh wrote a paper on this following a death in a psychiatric hospital (that did not involve ‘law enforcement’ in any way) and various British coroner’s have given this as a cause of death after hearing evidence from, amongst others, Home Office pathologists who refuse to say there’s nothing in this.

      Thank you for helping me reinforce my point – if you could let me know when you’ve sorted it out, I’d be grateful: those of us working 999 have jobs to go to.

  3. All sorts of issues raised here; I’d only heard vaguely of excited delirium until I saw this blog so researched it further. I can certainly see how it could occur in the case of someone who was taking stimulant, psychoactive drugs so I don’t think it could be said there’s nothing in it. The troublesome is that if there is hyper aggression how is it controlled? I’m not sure NHS procedures could adequately do so (particularly with the vast change in restraint training now underway) so I’ve no real answers there. I would always treat what a weapons company would say, they’re not exactly known for being moral. While I think there’s a case to be made for excited delirium I could certainly see how a weapons manufacturer could over state the case to justify deaths linked to their products. We’ve also seen cases in the US and indeed Canada where there HAS been excessive police/correctional violence that has resulted in death. Have to disagree with the first poster though, akathesia is something vastly different and doesn’t have hyper-aggression as a feature. Perhaps a safer way to manage would be specially designed rooms that can safely contain a person and reduce the risk of injury.

  4. Eric Balaban of the American Civil Liberties Union argued in 2007 that excited delirium was not recognized by the American Medical Association or the American Psychological Association and that the diagnosis served “as a means of white-washing what may be excessive use of force and inappropriate use of control techniques by officers during an arrest.”

    However the term “excited delirium” has been accepted by the National Association of Medical Examiners and the American College of Emergency Physicians, who argued in a 2009 white paper that “excited delirium” may be described by several codes within International Statistical Classification of Diseases and Related Health Problems.

    A 2010 systematic review published in the Journal of Forensic and Legal Medicine argued that the symptoms associated with excited delirium likely posed a far greater medical risk than the use of tasers, and that it seems unlikely that taser use significantly exacerbates the symptoms of excited delirium.

    Besides I’m quite sure Taser wasn’t around over a hundred years ago but in 1849 a similar condition to ED was described by Luther Bell as “Bell’s mania”.

  5. No-one is particularly qualified to take a scientific position on this because it’s not a scientific question.

    Like so many psychiatric ‘disorders’ throughout history (e.g. Drapetomania in the Southern United States, Sluggish Schizophrenia in the Soviet Union, Oppositional Defiant Disorder in the contemporary Anglosphere, Anosognosia when applied to those without acquired damage to the parietal lobe, homosexuality up until the mid 70s …) Acute Behavioural Disorder is a political label masquerading as a medical condition that we use to pathologise those we disapprove of.

    1. You’re helping to reinforce my point, because I can name you eminent doctors in the UK who will say that this absolutely is a scientific question involving a life-threatening medical condition, as rare as hens’ teeth and very, very real. There are others about who will not go as far as you have and whose obfuscation of the question stops just short of saying, “This isn’t real.”

      If you could all get back to me when you’ve all sorted it out, I’d be grateful becuase I’m not sure why to believe you and not the others. 👍🏼

      1. But science isn’t a matter of appeal to ’eminent’ authority. It’s supposed to rest on empirical evidence. If these ’eminents’ had an objective test that could reliably and reproducibly determine the existence or absence of ABD there would be little or no controversy.

        One of the many things I dislike about forensic psychiatry is that it attempts to take questions about how to respond to certain kinds of behaviour out of the political and legal realm and put them into the hands of ’eminent’ technocrats who have no special insights into civil society or human rights.

      2. Exactly so – if / when somebody’s got some, you can let me know. And it wasn’t about appeal to the eminent authority: just exposure of the contradictions that exist. I’m not siding with any of the authorities whatsoever – I’ve already outlined my utter lack of qualification to do so. Meanwhile, we know people are occasionally dying and that courts are saying people die from this: so it’s not a scientific question until science has something fully meanginful, empirically tested, to say about it.

        It’s therefore a social and legal one, until otherwise framed because ultimately, society and the legal system has to make real decisions about real cases. And regardless of what is going on scientifically, if we’re more or less expecting the police to restrain people to death for our greater benefit, we could accept that it’s probably best for them to do this in an environment where a medical intervention may be possible before such a tragedy (as per published and forthcoming guidelines) and where medical intervention is possible once such a tragedy is excruciatingly imminent.

      3. I think we’re in close agreement on this except that I find courts saying ‘people are dying of this’ rather than ‘people are being killed’ to be a particularly repugnant use of the passive voice to deny responsibility. As someone who has worked on death in custody issues for decades and seen very few lessons learned it’s something that particularly gets my goat.

  6. But when police only get basic first aid training why should they be deemed to have ‘killed’ somebody when the overarching cause is a medical one (which is even by emergency doctor level extremely hard to diagnose). Having seen incidents where officers suspect ABD yet still get turned away from A&E why trying to do the right thing I thinks it is unfair and unhelpful to suggest the police are always to blame. Besides whether you think ABD (or whatever name you choose to give it) is real or not the fact police do has resulted in better management of those suspected of suffering from it and will no doubt continue to do so.

    1. Are you trying to suggest these people are dropping dead spontaneously without any aggravating circumstance beyond ABD itself? That sure isn’t my understanding of what’s happening. If you’re talking about people who’ve ODed or are suffering a similar medical emergency being turned away from A&E that’s a completely different issue. But you’re not, are you?

      If I, as a non-LEO, was to hit someone who has a weak heart or is predisposed to stroke and that person died would you insist I hadn’t killed him but rather his disorder had? What about if he could have been saved with prompt medical intervention? Should the triage nurse be charged with homicide instead of me?

      In any case, there’s no pre- or postmortem test that can determine whether someone has ABD (even if the condition does exist), so using it to remove all responsibility from those who initiate the proximate cause of death will inevitably be abused. In fact it is abused. By police. By the manufacturers of Tasers. By coroners. By the judiciary. And by others.

      It’s that sort of evasion of responsibility that keeps deaths in custody persistently high (here in Australia at least – I can’t speak for wherever you are) and stymies any chance of institutional reform that might reduce them. It’s not as if Joe Citizen could ever get away with such pseudo-scientific and blatantly immoral blame-shifting, so why should cops? Or more to the point, why should authorities be able to shrug their shoulders and continue with the homicidal business as usual rather than initiate reforms that might reduce those sorts of outcomes?

      The criminologist Larry Sherman points out that procedural injustice is a major promoter of criminality in society. So what impact do you suppose the fact that UK and Australian police and prison officers are never imprisoned for homicides while on duty might have on the culture of violence, respect for rule of law and perceptions of police legitimacy in those countries? Especially when such transparent claptrap as ‘ABD’ is used to print their get-out-of-jail-free card.

  7. People have been dying after exhibiting similar symptoms for over a century WITHOUT police intervention however with the advent of better acountability and prolific media coverage people assume it only happens after police contact. An argument supported others in the medical community “Since the victims frequently die while being restrained or in the custody of law enforcement, there has been speculation over the years of police brutality being the underlying cause. However, it is important to note that the vast majority of deaths occur suddenly prior to police capture, in the emergency deparment or alone at home.”

    Yes, I’ve been turned away from A&E for people showing the signs and symptoms of ED and it was only because one of the doctors had recently had training on it that we were allowed in (and no it was not an OD or other medical issue). In the end the male was given a general anaesthetic to knock him out due to his behaviour and stayed that way for 3 days because everytime they tried to bring him out of it he exhibited the signs of ED. His diagnosis when prior to discharge was cocaine induced ED. Oh and the use of force was limited to handcuffs and good communication caught on body cam so no cover up needed.

    The argument that it’s a get out of jail free card is flawed because the argument FOR there being ED is growing in emergency medical circles and why would it be in their interests to perpetuate a myth? Sudden Infant Death Syndrome was once deemed a falacy by many in the medical community however is now accepted as being real, despite there still being no known single cause. Oh and there were people wrongly convicted of murder as a result too which sounds like what your advocating with ED.

    In addition here in the UK we are not routinely armed and Taser cover is limited which some studies suggest INCREASES the risk when people are sufferomg from ED as hands on restraint increases core body temperature to an greater extent than say Taser or CS.

    May I recommend reading the below article which tries to look at ED from a nutural stand poiny entitled:
    EXPLAINING THE UNEXPLAINABLE: EXCITED DELIRIUM SYNDROME AND ITS IMPACT ON THE OBJECTIVE REASONABLENESS STANDARD FOR ALLEGATIONS OF EXCESSIVE FORCE

    https://www.google.co.uk/url?sa=t&source=web&rct=j&url=http://connection.ebscohost.com/c/articles/74259332/explaining-unexplainable-excited-delirium-syndrome-impact-objective-reasonableness-standard-allegations-excessive-force&ved=0ahUKEwi6g5XtkevJAhXMOxoKHdlpBLEQFgggMAE&usg=AFQjCNFzJfzQhDxSyO9qSjXEwL2MXAFV0Q

    1. I’ve now read the article and am as underwhelmed as the authors who critically cite it (e.g. Sherene Razack in Dying from Improvement: Inquests and Inquiries into Indigenous Deaths in Custody). But I guess that’s a bit unfair as you couldn’t expect too much scientific rigour from an otherwise unpublished Nebraskan litigation lawyer, could you?

      Still, there’s some pretty stunning cognitive dissonance in his relating the story of someone dying after being tased, cuffed, beaten and crushed under “at least seven” police officers as an example of “where an individual dies during police contact from injuries insufficient to cause death” (all italics mine).

      His ignorance of how Emil Kraepelin categorised dementia praecox (the forerunner of the modern diagnosis of schizophrenia but with several case histories of probable epilepsy in the mix) doesn’t indicate he did much research for his article either.

      But I now see where you get your inappropriate comparison with SIDS.

      Yes, there have been wrongful homicide convictions following probable SIDS cases, both in the UK and here. But jerks like Roy Meadow notwithstanding there are also real cases of infanticide passed off as SIDS. But you can bet your bottom dollar that if an infant suddenly dies immediately after suffering known use of force by an adult any claims of SIDS will rightfully be taken with a huge grain of salt and, unlike killer cops, that person will be at real risk of prosecution and conviction.

      Whether or not SIDS is a real diagnosis has not been an issue in our lifetimes and was not an issue in the cases of Sally Clark, Trupti Patel or Angela Cannings. The issue is prosecutorial misconduct and a largely unskeptical judicial attitude towards bogus evidence given by ’eminent’ experts like Meadow.

      What’s particularly reprehensible about the way ABD & ED are used in death in custody cases is how they shift all agency from the police who used force towards the deceased victim. This is absolutely standard in how DICs are institutionally approached. Police don’t “shoot” people, their “weapons discharge” and “the suspects succumb to their injuries”. Chillingly Orwellian stuff.

      I think I agree with Brian Paddick that the farcical ritual of pretending to criminally investigate police for deaths in custody should probably be abolished. We all know the result before it even starts. There has never been a cop convicted of unlawful killing while on duty in Australia. No murders. No manslaughters. No negligent homicides. Nothing. I’m assured by my UK colleagues the situation is the same there. So why waste time and resources and put families of victims through unnecessary trauma? Why invent nonsensical conditions like ABD to try to shift blame away from the real killers?

      As Paddick says, doing away with the pretend threat of criminal sanctions might even encourage some cops to give honest accounts of what happened and provide an evidential basis for reforms that might eventually reduce DICs. But what I think is even more important is that it will dispense with the need to publicly blame (and often vilify) the victims – as so often happens following a DIC – and spare families the ordeal of being subjected to a process that’s fixed from the outset.

      1. It pains me to to have to point out to someone as obviously educated as you that the difference between adults who have used force on children in ‘SIDS’ type situations and officers in ‘ABD’ type situations is the issue of legality. I am all too aware that medics and scientists give scant regard to such issues as legality. There’s a difference. And it’s crucial.

      2. I think you’ll find it’s legal for parents to use reasonable force upon their children in pursuance of their parental duties, regardless of whether the right is enshrined in a statute book.

        And I fail to see why the legality or otherwise of an action is crucial when considering the morality or utility of blaming the victim for its outcome.

      3. Your use of the words ‘victim’ says a lot in this context.

        Indeed it does. Even when people die of purely medical causes or just bad luck they’re routinely referred to as victims – even if it’s just ‘victims of circumstance’.

        What do you suppose your objection to using the word ‘victim’ in the context of deaths resulting from the actions of police says about your attitude towards deaths in custody?

      4. It says that I’m inclined to remain neutral about whether or not is was, in fact, that actions of the police that caused the death and whether not such actions, if linked, was causal or contributory. This should be true of most of us until such time as links and liability are found.

        It’s interesting how your prepared to role with ‘victims’ as your working theory of DICs but feel entitled to object from the. Wry beginning about the original subject matter. As I say, when you’ve all sorted it you can get back to us. Until then, yours is one of many contradictory voices in a noisy debate that’s going in circles. Not just my opinion.

      5. It says that I’m inclined to remain neutral about whether or not is was, in fact, that actions of the police that caused the death

        Firstly, whether they died of medical causes or died of police brutality they would still be victims. The fact that you seem to object to using the standard English term in this case suggests to me that you want to set aside the fact that something very unfortunate has happened to someone in favour of contemplating the smokescreen used to obscure culpability for it.

        Secondly it would seem you seriously expect people to believe that many or all of the deaths recently attributed to ABD would still have happened even if police hadn’t used force against the victims. Do you really believe that? Perhaps you also believe Ian Tomlinson just happened to die of a heart attack moments after being struck by PC Harwood. It must just be extraordinarily bad luck the way people keep dying of natural causes immediately after being subjected to police violence.

      6. I notice you’ve isolated part of my previous reply for highlighting and omitted the bit about ‘until links and liability’ are found. Maybe it’s a product of being a police officer, but I tend to use ‘victim’ to mean ‘victim of (alleged) crime’ rather than in any general sense. I certainly don’t refer to ‘heart attack victims’ or ‘cancer victims’, for example. So please take any use of the word here to mean victim of crime, unless otherwise clarified.

        Nobody anywhere is or was arguing that deaths attributed to ABD would have been deaths anyway without an additional mechanism, but whether that mechanism was accident, misadventure or third-party intervention doesn’t strike me as being the point. The issue is whether police officers (and sometimes others!) are *obliged* to consider making an intervening in a situation to manage risks and threats and whether some mental health and / or physical health and / or drug and alcohol related backgrounds are going to create a dangerous situation once that intervention is attempted. (I feel pedantically inclined to keep reminding you, because of your obvious bias here, that so-called ABD deaths have also been reported in non-police settings … even if you are right about your various agenda, this is not just a police related problem.)

        Obviously, Mr HARWOOD was not entitled to do what he did – that can rightfully be described as police violence notwithstanding that the court convict him of manslaughter; other cases (perhaps your Sydney CBD incident is an example) show similar problems. But by no means have all officers been criticised for intervening in difficult situations like these where a death or serious injury has followed. You seem to like anecdotes from individual cases, so look up the case of Toni SPECK in York (UK) from 2011. At the recent inquest, one pathologist mentioned ABD/ED and the result came back that she died from Serotonin Syndrome (whatever that is). What was beyond doubt in that case, is the public health system wanted nothing whatsoever to do with her and no services were open to her. So police officers found themselves dealing with an agitated, vulnerable person in isolation and oddly enough, found that they could not resolve the situation without a certain level of restraint.

        There are problems with the police, the justice system handling of health and mental health related matters: this BLOG is evidence that I’ve banged on about all that more than most in the hope of chipping away. But don’t try to infer what you think I might mean because it suits your agenda: it really insults my intelligence.

      7. Call me one of those scientist types who has scant regard for legality if you like but I’m not after a legal or expert scientific opinion here. Just a little critical thinking.

        I have no doubt the question of the definition and existence of ABD is a mess from a legal perspective. It’s not as if there’s specific legislation about it and junk science is pretty routinely accepted as scientific evidence in our courts.

        Under expert witness admissibility standards akin to the US Federal Daubert standard, for ABD to be a scientific theory it would have to meet the Popperian requisite of being falsifiable. I don’t think it holds up well there. It’s pretty much impossible to prove someone who died suddenly and unexpectedly didn’t die of ABD – even if there seem to be more obvious precipitating factors.

        You can die of it if you take drugs. Illegal, legal or prescription. From side effects or withdrawal effects. You can die of it if you have a mental illness. If you have the other ABD (Acquired Brain Damage). If you strip off or otherwise seem to be overheated. If you have a cardiac or respiratory illness. If you have elevated adrenaline levels during a struggle with police …

        The main ‘symptoms’ cases tend to have in common are mostly tautological.

        The sufferer supposedly engages in distressed, dangerous or threatening behaviour, but as that forms the rationale for intervention by authorities it’s almost always going to be a feature of the case.

        So pretty much anyone who attracts forceful police intervention then dies qualifies for immediate diagnosis.

        ABD doesn’t fare too well under older standards like Frye either. You’re supposed to be able to show widespread expert support for the theory. While some people might be impressed by the policies of the Royal College of Emergency Medicine I think ABD’s lack of listing in any widely recognised diagnostic manual (such as ICD or DSM) would tell pretty heavily against it there.

        But not to worry. There’s plenty of much lower standards of scientific evidence to choose from that have been letting pseudoscience into the courtroom since Victorian times. They just expect the ‘expert’ to be recognised in his field – an ’eminent’ – to be able to say anything he likes in court and pretend it’s science.

        So yeah, at the bottom end of judicial standards of admissibility you can find legal precedent suggesting ABD is scientifically valid. As you once could for phrenology and race ‘science’. Fibre analysis and lie detectors. Criminal profiling and Satanic ritual abuse.

        But hey, let’s question whether we’re dealing with correlation or causality here? Maybe police use of force and death keep co-occuring because there’s some other factor common to both of them. The need for juicy media stories for instance. Or maybe there’s reverse causation. Police are somehow being incited to launch attacks on people about to die of ABD.

        So you can see why us scientific types don’t really go for the legal answers. Which isn’t to say they’re not valid arguments to have. They’re just not scientific arguments. And we’re kinda protective about the public reputation of science. We don’t like to see another load of junk sullying the brand. There’s more than enough of that as it is.

        Maybe my outlook and interests mean I’m not getting a representative picture of ABD. Maybe it does exist in the absence of official violence. Maybe I’m just exposed to a hugely unrepresentative sample in which the only factor victims had in common was the recent use of rigorous physical force upon them by authorities. If you know of cases in which ABD is listed as possible cause of death even though no recent forceful physical intervention took place I’d appreciate some references I might use to remedy my own ignorance.

        But in any case, if we’re going to pretend ABD exists don’t you think police violence is a frequent enough precursor to at least include it among precipitating factors? Rather than trying to use the diagnosis to discount the symptom.

      8. To make the discussion a bit more specific lets take a case I’m particularly familiar with, that of Roberto Curti,

        Mr Curti had taken LSD and was suffering paranoid delusions. He also removed most of his clothes, indicating he may have had metabolic temperature dysregulation. He took a cab to the Sydney CBD and shortly after arriving was beaten up by several unidentified men, apparently aggravating his distress. He entered a convenience store and took two packets of chocolate biscuits without paying. The store owner let it pass but a witness called NSW police who mistakenly called it as an armed robbery in progress, resulting in a response from several nearby units.

        Curti was initially intercepted by two officers but after a brief, incoherent conversation he ran from them. They pursued, repeatedly firing their tasers at him until they finally scored a hit and he collapsed and was immediately handcuffed.

        Shortly afterwards Mr Curti got up and attempted to flee but police tackled him and brought him down, with six police piling on top of him. While handcuffed and pinned under “half a tonne of police” he was tasered a further seven times and had three cans of capsicum spray emptied into his face from less than 15cm away. When the police got off him almost ten minutes later he was dead.

        As usual, the NSW Ombudsman declined to criticise the police for their actions. However, unusually, the NSW Coroner suggested consideration should be given to charging the police for excessive use of force. In DIC cases I’ve been involved in that has only ever happened twice before – each time when there were many non-police witnesses to the event who were talking to the media. The coroner was also very critical of the dishonest testimony police gave during the inquest. What’s more, the NSW Police Integrity Commission (which is made up mostly of police but is nowhere near as perversely biased and dishonest as your IPCC seems to be) recommended that the police involved be charged variously with assault or assault occasioning grievous bodily harm and with perjury over the evidence they gave the coroner.

        The DPP (our CPS) declined to bring perjury charges but the assault cases went ahead. However the defence called a parade of ‘expert’ witnesses who claimed that while positional asphyxia was a possible cause of death, so too was excited delirium. The magistrate found that cause of death could not be determined and instructed the jury to return ‘not guilty’ verdicts on all charges other than the common assault charge against the officer who used the cap spray. The jury returned a guilty verdict on that count and the judge put the officer on a good behaviour bond and ordered than no criminal conviction be recorded against him. He remains an active duty NSW police officer. The ranking police officer at the event who received particular criticism for his dishonest evidence at the inquest was promoted from Sergeant to Inspector immediately afterwards.

        Like Jean Charles de Menezes, Roberto Curti was a Brazilian citizen and the government of Brazil lodged a firmly worded diplomatic protest over how NSW authorities handled the case.

        So what do you think about this particular case?
        What about if you put it into the context of any number of other DIC cases in which police witnesses have blatantly lied through their teeth and authorities at multiple levels have contrived to ensure the lies remain unchallenged and unpunished?
        Do you really think cases recently attracting labels of ABD/ER are sincere attempts to describe a deadly medical condition or cynical attempts to pervert the course of justice?

      9. What do I think of this particular case? – you’re seriously expecting me to give an informed view on a case I’ve never heard of before from another country based on your summary?! … I know from experience how ridiculous that would be! — and am I seriously arguing that ABD/ED labels are a genuine attempt or a cynical perversion? – it should be clear from what I’ve written that I’m not arguing either (nor do I accept the premises that these are the only two options). I’m a cop: we go to work to help and protect people and have to take difficult decisions that others run away from and that will be debated in multiple legal hearings from years, if not decades.

        I have got the first f*cking clue, quite frankly, what to believe about ABD/ED – people whose credentials I cannot distinguish are saying diametrically opposed and ultimately vague things. I’ve acknowledged already I’m completely unqualified to judge the merits of this debate. I merely point out that for as long as debate continues (and it is ongoing as we speak in the UK Royal College of Emergency Medicine), police officers, paramedics and others will continue to be legally responsible for responding to incidents where they are obliged to use force to prevent harm to people and sometimes, incidents will occur where people exhibit significant resistance to detention and some of those people will have mental health problems, some will have taken drugs (legal and / or illegal) and there with be other relevant variables as well, including officers’ actions.

        The police and others are still obliged to try and achieve safe outcomes from incidents and In those rare cases where the worst occurs, whether a disastrous outcome would have resulted anyway; whether physical intervention aggravates factors already likely to place a person at risk of collapse; or whether the intervention is the direct cause of someone’s collapse and death – none of that inherently means that officers are guilty of criminal offences as long as they were acting lawfully and that’s what we have a legal system for. If you have an argument that your system needs improving, then make that argument by all means. Clearly some officers do make mistakes and clearly some of them do commit offences – we’ll see more in the future, I’m sure. But very many more were simply trying their best to do their job.

  8. Cabrogal. Are you seriously suggesting that UK police officers knowingly use force with the intent of causing serious injury, harm or even death, when faced with violent individuals they suspect might have MH issues? You honestly believe that when faced with a quite frankly frightening situation of a violent individual who may have no moral compass opertaing which lmits how far they are willing to harm someone, the first thing officers think is “oh goody, I can kill someone and get away with it”? You really believe that it crosses their minds when faced with these sort of impossible situations? Restraining a violent persons requires force. It requires more foce than the subject is using, by virtue of the fact that you need to firstly overcome, then restrain that violent individual. People get hurt, including cops. You have one of two choices. Restrain, which requires force & violence, or dont and allow them to continue whatever behaviour they are exhibiting. If its immediate behaviours of self harm or attempts to harm others & the cops dont have the luxury of criticism whilst hiding behind a keyboard, what do you propose? What would you do? Restrain and face the consequences if ti goes wrong? Dont restrain and face the consequences if it goes wrong? Your post absolutely reeks of a personal agenda and is so unbalanced and lacking in critical/analytical thinking, that it really doenst deserve serious consideration. How about the whole topic might just be a case of human beings, albiet in a uniform, trying to do their best in difficult circumstances when faced with fritghtening and violent situations. Someitmes it will go worng, as when faced with risk, you cannot remove risk entirely. The higher the risk, the worse the potential consequences if it goes wrong. To attemt to turn these into some sort of police conspiracy to kill people and get away with it, is a juvenille attempt to drag a serious topic into a worthless point scoring exercise.

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